Microsurgical Reconstruction of Noma-related Facial Defects with Folded Free Flaps: an Overview of 31 Cases

Noma is primarily affecting children in underprivileged countries and results in disfiguring facial defects, loss of mandibular movement, and subsequent social disintegration. Plastic surgery in West Africa traditionally uses pedicled flaps. In large, complex, or central facial defects, though, pedicled flaps are apt to be too small or have a significant donor site morbidity. Since 1999, we have been using free microvascular flaps in Nigeria. In 5 Interplast missions, 31 patients (age 5-45 years, median 20 years, female to male ratio 18:13) underwent 31 free flap procedures in Nigeria, 27 of them for primary treatment. The operative time ranged from 3.75-8.75 hours (mean 5.5 hours). An external distractor/fixator to maintain mouth opening was mounted in 13 cases. All anastomoses were done with loupe magnification. Three flaps failed completely, 1 partly, and 4 patients showed minor wound infections. No donor-site complications occurred. Free flaps can be a suitable and safe closure for complex noma defects even in underprivileged circumstances, if patient profile and own microsurgical routine allows it. Patient disfigurement can be less than in pedicled flaps regarding the donor sites.